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1.
Med Gas Res ; 13(1): 7-9, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-35946216

RESUMEN

Ischemic stroke happens when the blood supply to the brain is obstructed and it is associated with numerous complex mechanisms, such as activated apoptosis genes, oxidative stress and reaction of inflammation, which finally result in neurological deficits. Several gases have been proved to have neuroprotective roles, even the classic gases that are thought to be toxic such as hydrogen sulfide (H2S). H2S is the third identified endogenous gas signaling molecule following carbon monoxide and nitric oxide. H2S plays a significant role in stroke. Inhalation of H2S can attenuate cerebral infarct volume and promote neurological function in a rat model of middle cerebral artery occlusion to reduce ischemic stroke-induced injury in vivo and in vitro as a result. Therefore, H2S can be clinically used to reduce ischemic stroke-induced injury. This review introduces the toxic mechanisms and effects of H2S on cerebral ischemic stroke.


Asunto(s)
Sulfuro de Hidrógeno , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Animales , Encéfalo , Sulfuro de Hidrógeno/farmacología , Sulfuro de Hidrógeno/uso terapéutico , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Ratas , Accidente Cerebrovascular/tratamiento farmacológico
2.
J Hypertens ; 41(1): 83-89, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36205007

RESUMEN

OBJECTIVE: The sit-up test is used to assess orthostatic hypotension in stroke survivors who cannot stand independently without using a tilt table. However, no study has identified the optimal cut-points for orthostatic hypotension using the test. Therefore, this study aimed to examine the decrease in SBP and DBP during the sit-up test to detect orthostatic hypotension in individuals with stroke. METHODS: Thirty-eight individuals with stroke, recruited from three convalescent rehabilitation hospitals, underwent the sit-up and head-up tilt tests. Systolic and diastolic orthostatic hypotension was defined as a decrease of at least 20 and 10 mmHg in the SBP and DBP, respectively, during the head-up tilt test. The receiver operator characteristic curve with the Youden Index was used to identify the optimal cut-points. RESULTS: Eight and three participants showed systolic and diastolic orthostatic hypotension, respectively. The optimal cut-points for orthostatic hypotension using the sit-up test were a decrease of 10 mmHg in SBP [sensitivity = 87.5% (95% confidence interval: 47.4-99.7), specificity = 96.7% (82.8-99.9)] and 5 mmHg in DBP [sensitivity = 100.0% (29.2-100.0), specificity = 88.6% (73.3-96.8)]. CONCLUSION: Compared with the conventional cut-points, smaller cut-points of a decrease in SBP and DBP may be better to identify orthostatic hypotension in individuals with stroke using the sit-up test. The findings of this study may provide valuable information for the clinical application of the sit-up test.


Asunto(s)
Hipotensión Ortostática , Accidente Cerebrovascular , Humanos , Hipotensión Ortostática/diagnóstico , Hipotensión Ortostática/etiología , Presión Sanguínea/fisiología , Estudios Transversales , Accidente Cerebrovascular/complicaciones , Sobrevivientes
3.
Neuroimaging Clin N Am ; 33(1): 57-68, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36404047

RESUMEN

The coronavirus disease (COVID-19) pandemic has impacted many lives globally. Neurologic manifestations have been observed among individuals at various stages and severity of the disease, the most common being stroke. Prompt identification of these neurologic diagnoses can affect patient management and prognosis. This article discusses the acute neuroradiological features typical of COVID-19, including cerebrovascular disease, intracerebral hemorrhage, leukoencephalopathy, and sensory neuropathies.


Asunto(s)
COVID-19 , Accidente Cerebrovascular , Humanos , COVID-19/complicaciones , Hemorragia Cerebral , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Pronóstico
4.
J Affect Disord ; 321: 56-58, 2023 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-36280198

RESUMEN

This study investigated associations of anxiety at the acute phase with long-term outcomes of acute coronary syndrome (ACS) and stroke, and potential modifying effects of cardiovascular/cerebrovascular severity at onset. In 1152 ACS and 423 stroke patients with recent onset, long-term follow-up for cardio-cerebro-vascular outcomes was conducted. Acute-phase anxiety predicted long-term outcomes, but these associations were significant only in patients with great initial disease severities with significant interaction terms in both diseases after adjustment for relevant covariates. Clinical prediction of cardio-cerebro-vascular prognosis might be improved by screening for anxiety and disease severities in the acute phase of ACS and stroke.


Asunto(s)
Síndrome Coronario Agudo , Accidente Cerebrovascular , Humanos , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/diagnóstico , Accidente Cerebrovascular/complicaciones , Índice de Severidad de la Enfermedad , Pronóstico , Ansiedad , Factores de Riesgo
5.
J Affect Disord ; 321: 208-216, 2023 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-36349648

RESUMEN

BACKGROUND: Diabetes has a high incidence in China, which may cause stroke and depression. However, the relationship between diabetes and the incidence of new-onset stroke and depression has not been fully studied. METHODS: The data from the China Longitudinal Study on Health and Retirement (CHARLS) from 2013 to 2018 were used. A total of 8530 respondents aged ≥45 years old were included in the follow-up study. Logistic regression model, Cox regression, and Mediation analyses were used to explore the association between diabetes, depression, and new-onset stroke. RESULTS: The depression score of patients with diabetes history was higher (HR,95%CI = 1.02, 1.01-1.04) and were more likely to experience new-onset stroke events (HR, 95%CI = 1.046, 1.02-1.07). With a history of hypertension (HR,95%CI = 1.747, 1.381-2.208), older (HR,95%CI = 1.033, 1.020-1.046) with high BMI (HR,95%CI = 1.056, 1.027-1.086) have a high risk of new-onset stroke. In the combined subgroup analysis, the incidence of new-onset stroke in the subgroup with diabetes depression was higher than in others. The mediating effect of depression on new-onset stroke events in diabetic patients is more pronounced in the medium to long term (>3 years) after adjusting covariates. LIMITATIONS: We defined new-onset stroke by patient self-report, there might be some memory bias. In addition, new-onset stroke was not classified in the CHARLS questionnaire, which would hinder us to evaluate the mediating effect of depression on different types of new-onset stroke. CONCLUSION: Our results showed that depression has a partial mediating effect between diabetes and new-onset stroke in the middle-aged and elderly population in China.


Asunto(s)
Diabetes Mellitus , Accidente Cerebrovascular , Humanos , Anciano , Persona de Mediana Edad , Jubilación , Estudios Longitudinales , Estudios de Seguimiento , Depresión/epidemiología , Diabetes Mellitus/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , China/epidemiología
6.
Clin Rehabil ; 37(1): 132-142, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35785999

RESUMEN

OBJECTIVES: To investigate whether individuals' poststroke activity engagement is associated with their perceptions of stroke, as well as their perceptions of physical and social environment. DESIGN: Cross-sectional study. SETTING: Participants were recruited from eight rehabilitation settings in Beijing, China. PARTICIPANTS: A total of 202 dyads of community dwellers with stroke and their primary caregivers. MAIN MEASURES: Activity engagement measured by the Assessment of Life Habits; stroke individuals' and caregivers' illness perceptions measured by the Stroke-Specific Illness Perceptions Questionnaire - Revised; and stroke individuals' perceived social and physical environment measured by the Social Support Survey and abbreviated Neighborhood Environment Walkability Scale. RESULTS: A total of 202 dyads of individuals with stroke and their caregivers participated in the study with mean ages of 61.3 (8.3) and 52.6 (11.6), respectively. On average, stroke individuals scored 7.61 (1.42) on the daily activities subscale, indicating that they completed personal level activities without assistance but with some difficulty. They scored 6.21 (2.21) on the social roles subscale, suggesting that individuals completed societal level activities with assistive devices and with some difficulty. Illness perceptions correlated significantly with personal level activity engagement (change in R-squared = 0.029; p = 0.049), and perceived accessibility and heterogeneity correlated significantly with societal level activity engagement (change in R-squared = 0.025; p = 0.011). CONCLUSIONS: Poststroke activity engagement is associated not only with stroke individuals' performance skills but also with their perceptions of stroke, and how they perceive their physical environment. The findings may assist clinicians' decision making when developing comprehensive, targeted interventions for improving activity engagement and maximizing recovery after stroke.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Estudios Transversales , Cuidadores , Accidente Cerebrovascular/diagnóstico , Encuestas y Cuestionarios
7.
West J Nurs Res ; 45(1): 55-66, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35711105

RESUMEN

Prehospital delay after stroke symptom onset is a primary barrier to eligibility for reperfusion therapies. Decision delay is an understudied contributor to prehospital delay. We aimed to explore decision delay as a component of prehospital delay. For this correlational study, 170 Thai acute stroke patients were interviewed to explore their treatment-seeking decision factors: prior stroke knowledge, onset context, and cognitive, emotional, and behavioral factors. Participants' mean age was 61.2 years, and 46% were women. Median decision delay and prehospital delay times were 120 and 372 minutes. Decision delay represented 49% of prehospital delays. Factors shortening decision delay were atrial fibrillation, prior stroke knowledge, perceived cause of symptoms as stroke, perceived severity of symptoms, and advice from bystanders to seek treatment. In contrast, seeking support from others and self-treatment affected prolonged decision delay. Shortening decision delay, often under the patient or bystander control, can reduce overall prehospital delay.


Asunto(s)
Servicios Médicos de Urgencia , Accidente Cerebrovascular , Humanos , Femenino , Persona de Mediana Edad , Masculino , Factores de Tiempo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia
8.
Magn Reson Imaging ; 95: 19-26, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36252694

RESUMEN

PURPOSE: Using constrained spherical deconvolution (CSD)-based tractography, we aimed to obtain conjoint analysis of diffusion measures of major language white matter (WM) tracts in post-stroke aphasic patients bilaterally, and to correlate the measures of each tract to the different language deficits. MATERIAL AND METHODS: 17 aphasic patients with left hemispheric stroke, at the subacute stage, and ten age- matched controls underwent diffusion MRI examination. CSD-based tractography was performed. Diffusion measures [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)] were extracted after dissection of major language tracts bilaterally. Aphasia was assessed using language subset of hemispheric stroke scale. Comparisons of diffusion measures, for all tracts, between the two groups were performed. Partial correlations between the diffusion measures and different language components were obtained. RESULTS: In the left hemisphere, significant lower FA and or higher MD with higher RD of patients' WM tracts compared to the control group. Significant differences of diffusion measures were also evident in the right hemisphere yet, less prominent. All changes reflected damage of the tracts' integrity. Significant correlations were found between comprehension and FA of the left arcuate fasciculus (AF) and left inferior longitudinal fasciculus. Additionally, a significant correlation was found between MD of the right AF and repetition. CONCLUSION: Conjoint analysis of diffusion measures, based on CSD tractography, can provide important markers for the underlying WM changes bilaterally. Moreover, our findings emphasize that language processing can be mediated by both ventral and dorsal streams and further highlight the contribution of the right AF in repetition.


Asunto(s)
Afasia , Accidente Cerebrovascular , Sustancia Blanca , Humanos , Sustancia Blanca/diagnóstico por imagen , Lenguaje , Imagen de Difusión Tensora , Vías Nerviosas , Afasia/diagnóstico por imagen , Afasia/etiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen
9.
Curr Probl Cardiol ; 48(1): 101427, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36174742

RESUMEN

The use of mechanical circulatory support (MCS) in cardiogenic shock (CS) is increasing. We conducted a systematic review and meta-analysis to compare the outcomes of Impella use with extracorporeal membranous oxygenation (ECMO) support in patients with CS. We searched the Medline, EMBASE, Cochrane, and Clinicaltrials.gov databases for observational studies comparing Impella to ECMO in patients with CS. Risk ratios (RRs) for categorical variables and standardized mean differences (SMDs) for continuous variables were calculated with 95% confidence intervals (CIs) using a random-effects model. Twelve retrospective studies and one prospective study (Impella n=6652, ECMO n=1232) were identified. Impella use was associated with lower incidence of in-hospital mortality (RR 0.88 [95% CI 0.80-0.94], P=0.0004), stroke (RR 0.30 [0.21-0.42], P<0.00001), access-site bleeding (RR 0.50 [0.37-0.69], P<0.0001), major bleeding (RR 0.56 [0.39-0.80], P=0.002), and limb ischemia (RR 0.42 [0.27-0.65], P=0.0001). Baseline lactate levels were significantly lower in the Impella group (SMD -0.52 [-0.73- -0.31], P<0.00001). There was no significant difference in mortality at 6-12 months, MCS duration, need for MCS escalation, bridge-to-LVAD or heart transplant, and renal replacement therapy use between Impella and ECMO groups. In patients with CS, Impella device use was associated with lower in-hospital mortality, stroke, and device-related complications than ECMO. However, patients in the ECMO group had higher baseline lactate levels.


Asunto(s)
Oxigenación por Membrana Extracorpórea , Corazón Auxiliar , Accidente Cerebrovascular , Humanos , Choque Cardiogénico/terapia , Choque Cardiogénico/etiología , Oxigenación por Membrana Extracorpórea/efectos adversos , Corazón Auxiliar/efectos adversos , Estudios Retrospectivos , Estudios Prospectivos , Resultado del Tratamiento , Accidente Cerebrovascular/etiología , Lactatos
10.
Curr Probl Cardiol ; 48(1): 101438, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36191694

RESUMEN

The most common cardiac arrhythmia is Atrial Fibrillation. The prevalence of AF has doubled in the last 30 years and has become a 21st century epidemic. Various studies have found that the overall burden of AF is larger in developed communities as well as higher-income nations. Data on AF were collected from the GBD database from 2010 to 2019, while HDI data was derived from the UNDP website. Men had a higher incidence than women, although women had a higher mortality. South America, West Europe, and South Africa had higher MIR (Mortality-to-Incidence Rate) than other countries. In the last study years, MIR significantly was higher in more developed countries. According to differences between genders and various countries, by expansion of the infrastructures and diagnostic methods such as electrocardiography and continuous training of doctors for early diagnosis, we can help in better management of AF and controlling this silent pandemic.


Asunto(s)
Fibrilación Atrial , Accidente Cerebrovascular , Humanos , Femenino , Masculino , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/complicaciones , Incidencia , Carga Global de Enfermedades , Accidente Cerebrovascular/etiología , Factores de Riesgo , Prevalencia
11.
Vasc Endovascular Surg ; 57(1): 35-40, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36113165

RESUMEN

INTRODUCTION: Transcarotid artery revascularization (TCAR) is a hybrid open and endovascular technique to treat carotid stenosis. The purpose of this study is to present a large cohort of patients who underwent TCAR at 2 high-volume TCAR health systems. METHODS: This study was a retrospective chart review of all instances of TCAR within the Memorial Hermann Health System and Indiana University Health, from December 2015-January 2022, using the ENROUTE Neuroprotection Device (Silk Road Medical, Sunnyvale, CA). We report patient demographics, intraoperative metrics, 30-day results and long-term results. RESULTS: In all, 750 patients underwent TCAR in the designated time period. Average patient age was 73 years, with 68% being male. Overall, 53.9% of patients had coronary artery disease, 45.4% had diabetes, and 36.9% were symptomatic. Technical success was achieved in 98.8% of patients with conversion to open endarterectomy in 1.1%. Average reverse flow time was 9.1 minutes with length of stay greater than 1 day 38%. Ipsilateral stroke rate within 30 days was 2.3% and long-term cumulative stroke rate was 3.0%. Death within 30 days occurred in 1.2% of patients and in 5.9% over long-term follow up. In all, 1% of patients required reintervention. CONCLUSIONS: TCAR is a safe and effective treatment modality for carotid artery stenotic disease. Its outcomes are similar to historical results associated with carotid endarterectomy, long considered the gold standard.


Asunto(s)
Enfermedades de las Arterias Carótidas , Estenosis Carotídea , Procedimientos Endovasculares , Accidente Cerebrovascular , Humanos , Masculino , Anciano , Femenino , Estudios Retrospectivos , Resultado del Tratamiento , Factores de Riesgo , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Enfermedades de las Arterias Carótidas/cirugía , Accidente Cerebrovascular/etiología , Arterias , Stents
12.
Vasc Endovascular Surg ; 57(1): 48-52, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36167464

RESUMEN

OBJECTIVE: Several studies suggest that females have higher perioperative adverse events and decreased benefit from carotid artery revascularization with transfemoral carotid artery stenting and carotid endarterectomy (CEA) compared to males. However, there are limited data of sex-based outcomes for transcarotid artery revascularization (TCAR). METHODS: A retrospective review of prospectively maintained system-wide TCAR databases was performed between December 2015-January 2022. Patients who underwent TCAR were stratified based on sex. Relevant demographics, medical conditions, anatomical characteristics, intra- and postoperative courses, and adverse events were captured. RESULTS: 729 patients underwent TCAR, 486 (66.6%) male and 243 (33.3%) female. Males were more likely to be diagnosed with coronary artery disease (56.9% vs 47.7%, P<.01) and were active smokers (30.4% vs 21.4%, P < .01). Age, symptomatic status, BMI, hypertension, hyperlipidemia, diabetes mellitus, arrhythmia, chronic obstructive pulmonary disease, history of myocardial infarction, heart failure with reduced ejection fraction <30%, end-stage renal disease and Charlson Comorbidity Index were similar. In the perioperative period, there was no significant difference in reintervention rates (1.6% vs 1.2%, P = .75), cranial nerve palsy (.6% vs .4%, P > .99), ipsilateral stroke (1.9% vs 3.3%, P = .29), stent thrombosis (.4% vs .8%, P > .99), myocardial infarction (0% vs 0%, P > .99) and death (1.2% vs 1.2%, P > .99). In follow-up, no significant difference was found in reintervention, ipsilateral stroke, contralateral stroke, myocardial infarction, in-stent restenosis >50%, stent thrombosis, and death. CONCLUSIONS: Males and females did not have a statistically significant difference in outcomes when comparing ipsilateral stroke, in-stent thrombosis, conversion to CEA, and death after TCAR. However, our cohort comprised predominantly male patients and may conceal statistical significance as the females in our cohort did have a higher tendency toward developing complications. Future studies with a larger female cohort should be conducted to determine whether there is a true disparity of outcomes between the males and females undergoing TCAR.


Asunto(s)
Estenosis Carotídea , Procedimientos Endovasculares , Infarto del Miocardio , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Stents/efectos adversos , Procedimientos Endovasculares/efectos adversos , Resultado del Tratamiento , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Infarto del Miocardio/complicaciones , Arterias Carótidas
13.
J Affect Disord ; 320: 370-380, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36209775

RESUMEN

INTRODUCTION: Post-stroke depression (PSD) is the most common emotional problem following a stroke. White matter hyperintensities (WMHs) are often reported in patients with a stroke, and are often divided into deep WMHs (DWMHs) and periventricular WMHs (PVWMHs). The relationship between WMHs and PSD remains controversial. This review aims to resolve this controversy. METHODS: A systematic search of electronic databases was conducted for studies. We extracted the relevant data and evaluated the study quality by using the Newcastle-Ottawa Scale. We pooled odds ratios (OR) for the same type of WMHs that were present in the relevant PSD period. RESULTS: 15 studies (n = 4133 patients) met our inclusion criteria. In the acute phase, WMHs, DWMHs, severe WMHs, and severe DWMHs were not significant risk factors for incident depression, but PVWMHs (pooled OR, 1.21; 95 % CI, 1.01-1.44) and severe PVWMHs (pooled OR, 1.72; 95 % CI, 1.12-2.65) had a significant association with PSD. In the subacute phase, DWMHs, DWMHs, and severe WMHs were not significantly associated with PSD, but PVWMHs (pooled OR, 2.44; 95 % CI, 1.25-4.76) showed a significant association with PSD. In the chronic phase, severe PVWMHs had no significant association with PSD, while WMHs (pooled OR, 1.063; 95 % CI, 1.03-1.09), DWMHs (pooled OR, 1.40; 95 % CI, 1.11-1.76), PVWMHs (pooled OR, 1.28; 95 % CI, 1.11-1.48), and severe DWMHs (pooled OR, 1.52; 95 % CI, 1.12-2.05) showed a significant association with PSD. CONCLUSION: We found a significant association between WMHs/DWMHs/PVWMHs and PSD in the chronic post-stroke phase. PVWMHs had a stronger correlation with PSD in each period after stroke than WMHs and DWMHs. High-quality prospective studies are still needed to fully resolve this relationship.


Asunto(s)
Accidente Cerebrovascular , Sustancia Blanca , Humanos , Sustancia Blanca/diagnóstico por imagen , Depresión/etiología , Accidente Cerebrovascular/complicaciones , Imagen de Difusión por Resonancia Magnética , Oportunidad Relativa , Imagen por Resonancia Magnética
14.
Behav Brain Res ; 437: 114104, 2023 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-36100011

RESUMEN

Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke, which seriously affects the quality of life and prognosis of patients. Nevertheless, the pathogenesis of PSD remains unclear. In our study, a PSD rat model was established by chronic restraint stress (CRS) combined with middle cerebral artery occlusion (MCAO). Depressive and anxiety-like behaviors were tested, as well as Neuronal loss and Apoptosis. The expression of synapse and p38 MAPK signaling pathway -relevant proteins was detected. Our data indicated that CRS combined with MCAO could induce depression-like and anxiety-like behaviors, which led to neuronal damage, apoptosis, and cellular loss in the left parietal cortex and left hippocampus. Furthermore, CRS combined with MCAO decreased synaptic plasticity in the parietal cortex and left hippocampus. We found that CRS combined with MCAO had activated the p38 MAPK signaling pathway, and decreased the expression of pathway-related proteins MKK6 and MKK3. These results suggested that CRS combined with MCAO could lead to depression-like behavior via neuronal damage, apoptosis and reduced synaptic plasticity, which might be related to the activation of the p38 MAPK pathway. Therefore, it provides novel ideas for the research on the intervention and prevention mechanisms of PSD.


Asunto(s)
Arteriopatías Oclusivas , Depresión , Infarto de la Arteria Cerebral Media , Estrés Psicológico , Accidente Cerebrovascular , Proteínas Quinasas p38 Activadas por Mitógenos , Animales , Ratas , Depresión/etiología , Depresión/metabolismo , Depresión/psicología , Modelos Animales de Enfermedad , Infarto de la Arteria Cerebral Media/etiología , Infarto de la Arteria Cerebral Media/metabolismo , Infarto de la Arteria Cerebral Media/patología , Infarto de la Arteria Cerebral Media/psicología , Proteínas Quinasas p38 Activadas por Mitógenos/metabolismo , Calidad de Vida , Ratas Sprague-Dawley , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/metabolismo , Accidente Cerebrovascular/psicología , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/metabolismo , Sinapsis/metabolismo , Transducción de Señal , Restricción Física/efectos adversos , Restricción Física/fisiología , Restricción Física/psicología , Enfermedad Crónica , Estrés Psicológico/etiología , Estrés Psicológico/metabolismo , Estrés Psicológico/psicología , Apoptosis , Ansiedad/etiología , Ansiedad/metabolismo , Ansiedad/psicología , Corteza Cerebral/metabolismo , Corteza Cerebral/patología , Hipocampo/metabolismo , Hipocampo/patología , Neuronas/metabolismo , Neuronas/patología , Quinasas de Proteína Quinasa Activadas por Mitógenos/metabolismo
15.
Arch Gerontol Geriatr ; 104: 104832, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36219895

RESUMEN

BACKGROUND AND PURPOSE: The aim of this nationwide study was to assess the impact of the COVID-19 pandemic on cerebrovascular disease hospitalization rates, out-of-pocket rates, and in-hospital case fatality rates. METHODS: All hospitalizations for cerebrovascular disease from 1599 hospitals from 2019 to 2020 were selected using the International Classification of Diseases, 10th revision, in the Hospital Quality Monitoring System (HQMS). We defined 2019 as the pre-pandemic group and 2020 as the post-pandemic group. Multivariate analyses were done to assess the association between the pandemic and patient outcomes and out-of-pocket rate with odds ratios (OR) and 95% CIs presented. RESULTS: In total, 9 640 788 patients with the cerebrovascular disease were recruited (mean age was 65.7[SE.0.004] years, and 55.7% were male), and data is available for 5145358 patients in 2019 (pre-epidemic) and 4495430 patients in 2020(post-pandemic), indicating a 12.6% decrease. Out-of-pocket rate increase of 9.3% (2020 vs 2019: 34.1%% vs 31.2% [absolute difference, 2.9% {95% CI, 1.3% to 4.5%}, odd ratio {OR}, 1.1{95% CI, 1.0 to 1.1}]. The epidemic has led to an 18.0% increase in in-hospital mortality (2020 vs 2019: 1.1%% vs 0.9% [absolute difference, 0.2% {95% CI, 0.1% to 0.2%}, odd ratio {OR}, 1.1{95% CI, 1.1 to 1.2}]. The epidemic has led to significantly increased in-hospital mortality for patients with stroke but had no significant impact on other cerebrovascular diseases. CONCLUSIONS: During the COVID-19 pandemic lockdown, patients hospitalized for stroke fell by 12.6%, and there were substantial increases in out-of-pocket rates (9.3%) and in-hospital case fatality rates (18.0%).


Asunto(s)
COVID-19 , Trastornos Cerebrovasculares , Accidente Cerebrovascular , Humanos , Masculino , Anciano , Femenino , Mortalidad Hospitalaria , Pandemias , Control de Enfermedades Transmisibles , Hospitalización , Trastornos Cerebrovasculares/epidemiología , Accidente Cerebrovascular/epidemiología
16.
Magn Reson Med ; 89(2): 565-576, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36300851

RESUMEN

PURPOSE: The average saturation efficiency filter (ASEF) is a novel method of improving the specificity of CEST; however, there is a mismatch between the magnetization transfer (MT) effect under high-duty cycle and low-duty cycle pulse trains. We explore measures of mitigation and the sensitivity and potential of ASEF imaging in phantoms and stroke rats. METHODS: Simulation and nicotinamide phantoms in denatured protein were used to investigate the effect of different average saturation powers and MT pool parameters on matching coefficients used for correction as well as the ASEF ratio signal and baseline. Then, in vivo studies were performed in stroke rodents to further investigate the sensitivity and fidelity of ASEF ratio spectra. RESULTS: Simulation and studies of nicotinamide phantoms show that the matching coefficient needed to correct the baseline MT mismatch is strongly dependent on the average saturation power. In vivo studies in stroke rodents show that the matching coefficient required to correct the baseline MT mismatch is different for normal versus ischemic tissue. Thus, a baseline correction was performed to further suppress the residue MT mismatch. After correction of the mismatch, ASEF ratio achieved comparable contrast at 3.6 ppm between normal and ischemic tissue when compared to the apparent amide proton transfer (APT*) approach. Moreover, contrasts for 2.0 and 2.6 ppm were also ascertainable from the same spectra. CONCLUSION: ASEF can improve the CEST signal specificity of slow exchange labile protons such as amide and guanidyl, with small loss to sensitivity. It has strong potential in the CEST imaging of various diseases.


Asunto(s)
Roedores , Accidente Cerebrovascular , Animales , Ratas , Roedores/metabolismo , Imagen por Resonancia Magnética/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Protones , Amidas/química , Niacinamida
17.
Maturitas ; 167: 60-65, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36306668

RESUMEN

Cardio- and cerebrovascular diseases are leading causes of death and morbidity in ageing populations. While numerous cohort studies show inverse associations of presumably healthy lifestyles and cardiovascular risk factors, the causal link to many modifiable behaviors is still insufficiently evidence-based. Because of bias of studies and heterogeneity of results, we performed a systematic review of meta-analyses of randomized controlled trials and observational studies on lifestyle patterns including nutrition, physical activity, smoking, and weight versus incidence and mortality of cardio- and cerebrovascular diseases. A search string retrieved 624 references in PubMed covering the last five years. Two researchers screened titles and abstracts independently but with equivalent results. Nineteen references met the inclusion criteria. Results affirm that high adherence to plant-based diets, including components such as fruits, vegetables, legumes, whole grains, low-fat dairy, olive oil, nuts, and low intake of sodium, sweetened beverages, alcohol, and red and processed meats, results in lower risk of vascular outcomes in a dose-dependent manner. Physical activity quantified as walking pace or cardiorespiratory fitness yielded an inverse effect on stroke. Health measures such as smoking status, BMI and increase in body weight are associated with substantial risk of the incidence of and mortality from cardio- and cerebrovascular diseases, while strong adherence to an overall prudent lifestyle lowered the risk of cardiovascular disease by 66 % and that stroke by 60 %. In summary, increasing numbers of and adherence to health behaviors may markedly lower the burden of cardio- and cerebrovascular diseases. However, future research should focus on randomized controlled trials to test for causal relationships.


Asunto(s)
Enfermedades Cardiovasculares , Trastornos Cerebrovasculares , Accidente Cerebrovascular , Humanos , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/prevención & control , Estilo de Vida , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Verduras , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/prevención & control
18.
Curr Probl Cardiol ; 48(1): 101439, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36202174

RESUMEN

Fabry disease (FD) is a rare, progressive, X-linked inherited disorder of glycosphingolipid metabolism. It is a monogenic disease due to α-galactosidase A (α-GAL) enzyme deficiency, leading to the accumulation of globotriaosylceramide (GL3) within lysosomes beginning in utero. Multiple systems are involved, most notably the vascular, renal, cardiac, and nervous systems. Early clinical manifestations include neuropathic pain, angiokeratomas, anhidrosis, cornea verticillata, and gastrointestinal symptoms. In the later stages, FD manifests with transient ischemic attacks, strokes, hearing loss, and life-threatening complications involving the kidneys and heart. Cardiac involvement in Fabry disease is typically characterized by increased left ventricular wall thickness/mass, functional abnormalities, valvular heart disease, arrhythmias, and heart failure. The life expectancy of the patient with untreated Fabry disease falls significantly once cardiac or renal manifestations develop. This review will focus on the cardiac manifestations of FD and the role of multimodality imaging in diagnosis and follow-up.


Asunto(s)
Enfermedad de Fabry , Accidente Cerebrovascular , Humanos , Enfermedad de Fabry/complicaciones , Enfermedad de Fabry/diagnóstico , Enfermedad de Fabry/tratamiento farmacológico , alfa-Galactosidasa/metabolismo , alfa-Galactosidasa/uso terapéutico , Riñón , Arritmias Cardíacas
19.
Sci Total Environ ; 856(Pt 2): 159104, 2023 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-36208745

RESUMEN

BACKGROUND: To estimate the associations between ambient particulate matter (PM) pollution of different sizes (PM1, PM2.5, and PM10) and risk of rehospitalization among stroke patients, as well as the attributable burden in China. METHODS: We built a cohort of 1,066,752 participants with an index stroke hospitalization in Sichuan, China from 2017 to 2019. Seven-day and annual average exposures to PM pollution prior to the date of the index hospitalization were linked with residential address using a bilinear interpolation approach. Cox proportional hazard models were constructed to assess the association between ambient PM and the risk of rehospitalization. The burden of stroke rehospitalization was estimated using a counterfactual approach. RESULTS: 245,457 (23.0 %) participants experienced rehospitalization during a mean of 1.15 years (SD: 0.90 years) of follow-up. Seven-day average concentrations of PM were associated with increased risk of rehospitalization: the hazard ratios (HRs) per 10 µg/m3 were 1.034 (95 % confidence interval [CI]: 1.029-1.038) for PM1, 1.033 (1.031-1.036) for PM2.5, and 1.030 (1.028-1.031) for PM10; the hazard ratios were larger for annual average concentrations: 1.082 (1.074-1.090) for PM1, 1.109 (1.104-1.114) for PM2.5, and 1.103 (1.099-1.106) for PM10. The associations were stronger in participants who were female, of minority ethnicity (non-Han Chinese), who suffered from an ischemic stroke, and those admitted under normal conditions. Population attributable fractions for stroke rehospitalization ranged from 4.66 % (95 % CI: 1.69 % to 7.63 %) for the 7-day average of PM1 to 17.05 % (14.27 % to 19.83 %) for the annual average of PM10; the reducible average cost of rehospitalization per participant attributable to PM ranged from 492.09 (178.19 to 806) RMB for the 7-day average of PM1 to 1801.65 (1507.89 to 2095.41) RMB for the annual average of PM10. CONCLUSIONS: Ambient PM pollution may increase the risk of rehospitalization in stroke patients and is responsible for a significant burden of stroke rehospitalization.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Accidente Cerebrovascular , Humanos , Femenino , Masculino , Material Particulado/análisis , Contaminantes Atmosféricos/análisis , Estudios de Cohortes , Contaminación del Aire/análisis , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/inducido químicamente , Exposición a Riesgos Ambientales/análisis , Hospitalización , China/epidemiología
20.
J Ethnopharmacol ; 301: 115764, 2023 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-36183951

RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: Ligusticum striatum DC., also known as Ligusticum chuanxiong Hort. (LCH), is widely used in China for its excellent effect in ischaemic stroke (IS) patients, and borneol (BO) has been confirmed to maintain the blood‒brain barrier (BBB) after stroke. They are often used as a combination in the prescriptions of IS patients. Although the advantage of their combined treatment in improving brain ischaemia has been verified, their synergistic mechanism on BBB maintenance is still unclear. AIM OF THE STUDY: This study was designed to evaluate the synergistic effect of maintaining the BBB between LCH and BO against IS and to further explore the potential mechanism. MATERIALS AND METHODS: After primary mouse brain microvascular endothelial cells (BMECs) were extracted and identified, the duration of oxygen-glucose deprivation (OGD) and the doses of LCH and BO were optimized. Then, the cells were divided into five groups: control, model, LCH, BO, and LCH + BO. Cell viability, injury degree, proliferation and migration were detected by CCK-8, LDH, EdU and wound-healing assays, respectively. Hoechst 33342 staining was adopted to detect the apoptosis rate, and western blotting was employed to observe the expressions of Bax, Bcl-2, caspase-3 and cleaved caspase-3. The TEER value and NaF permeability were measured to assess tight junction (TJ) function, while ZO-1, occludin and claudin-5 were also probed by western blotting. Moreover, the HIF-1α/VEGF pathway was observed to explore the underlying mechanism of BBB maintenance. In vivo, global cerebral ischaemia/reperfusion (GCIR) surgery was performed to establish an IS model. After treatment with LCH (200 mg/kg) and/or BO (160 mg/kg), histopathological structure and BMECs repair were observed by HE staining and immunohistochemistry of vWF. Meanwhile, TJ-associated proteins in vivo were also detected by western blotting. RESULTS: Basically, LCH and BO had different emphases. LCH significantly attenuated the vacuolar structure, nuclear pyknosis and neuronal loss of GCIR mice, while BO focused on promoting BMECs proliferation and angiogenesis and inhibiting the degradation of TJ-associated proteins in vivo after IS. Interestingly, their combination further enhanced these effects. OGD injury markedly reduced the viability, proliferation and migration of primary BMECs; decreased the ratio of Bcl-2/Bax, TEER value, and the expressions of ZO-1, occludin and claudin-5; induced LDH release and apoptosis; and increased the cleaved caspase-3/caspase-3 ratio and NaF permeability. Meanwhile, BO might be the main contributor to the combinative treatment in ameliorating OGD-induced damage of BMECs and degradation of TJ-related proteins, and the potential mechanism might be involved in upregulating the HIF-1α/VEGF signalling pathway. Although LCH showed no obvious improvement, it could enhance the therapeutic effect of BO. Interestingly, their combination even produced some new improvements, including the reduction of cleaved caspase-3 and increase in TEER value, none of which were exhibited in their monotherapies. CONCLUSIONS: LCH and BO exhibited complementary therapeutic features in alleviating cerebral ischaemic injury by inhibiting BMECs apoptosis, maintaining the BBB and attenuating the loss of neurons. LCH preferred to protect ischaemic neurons, while BO played a key role in protecting BMECs, maintaining the BBB and TJs by activating the HIF-1α/VEGF signalling pathway.


Asunto(s)
Isquemia Encefálica , Ligusticum , Accidente Cerebrovascular , Animales , Ratones , Proteína X Asociada a bcl-2/metabolismo , Barrera Hematoencefálica , Isquemia Encefálica/metabolismo , Caspasa 3/metabolismo , Claudina-5/metabolismo , Células Endoteliales , Glucosa/metabolismo , Ocludina/metabolismo , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Accidente Cerebrovascular/tratamiento farmacológico , Proteínas de Uniones Estrechas/metabolismo , Uniones Estrechas , Factor A de Crecimiento Endotelial Vascular/metabolismo
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